Uncinatotomy: performing endoscopic sinus surgery without an uncinectomy

The results of endoscopic sinus surgery performed for chronic rhinosinusitis are controversial. For a better surgical outcome, different surgical techniques involving an uncinectomy as the primary step of the operation have been proposed. The surgery should resolve the pathophysiologic problems caused by the disease and preserve the normal anatomy and physiology. We developed a technique to remove the pathology localized to isolated maxillary and anterior ethmoid cells, without excising the uncinate process. The infundibular area was exposed with medialization of the uncinate with a bipedicle flap prepared 1.5 cm from the insertion of the uncinate to the nasal wall, and then the sinus pathology was removed. At the end of the surgery, the uncinate was returned to its original position. We performed this new technique to 3 patients and evaluated postoperative results. Primary disease was eradicated, and no complication was noted. With this technique, it is possible to perform all steps of sinus surgery without excising any anatomic structure.